Healthcare Provider Details

I. General information

NPI: 1306997291
Provider Name (Legal Business Name): LILY RUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PENN PLAZA, 7TH FL. STE. 725 EVERCARE
NEW YORK NY
10119
US

IV. Provider business mailing address

1 PENN PLAZA, 7TH FL. STE. 725 EVERCARE
NEW YORK NY
10119
US

V. Phone/Fax

Practice location:
  • Phone: 212-216-6465
  • Fax: 212-216-6606
Mailing address:
  • Phone: 212-216-6465
  • Fax: 212-216-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number304190
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: